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General NPI Number Information
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NPI Number | 1609626217
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VOICE AND SPEECH THERAPY PC
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 457 SUTTON WAY
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City | GRASS VALLEY
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State | CA
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Zip | 95945-4102
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Country | US
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Telephone | 530-264-8838
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Fax | 530-389-3338
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Provider Business Mailing Address
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Address Line | 263 MANOR DR
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City | GRASS VALLEY
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State | CA
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Zip | 95945-4003
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Country | US
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Telephone | 530-709-1408
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Fax | 530-389-3338
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Authorized Official
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Title or Position | PRESIDENT
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Name | MITCHELL PECK ENG
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Credential | MS, CCC-SLP
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Telephone | 530-709-1408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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